INSTRUCTIONS (Please Tear Off These Pages Before Submitting Petition)

Transcription

1 U.S. Department of Justice Immigration and Naturalization Service OMB # Petition for Approval of School for Attendance by Nonimmigrant Student INSTRUCTIONS (Please Tear Off These Pages Before Submitting Petition) I. Purpose of This Form. Form I-17 and Supplements A and B are used by a school or school system as specified below to request approval from the Immigration and Naturalization Service (INS) to admit nonimmigrant (F-1 and/or M-1) students. The petitioning school must establish that it is a bona fide school or school system by demonstrating that: (1) it is an established institution of learning or other recognized place of study, (2) it possesses the necessary facilities, personnel and finances to conduct instruction in recognized courses, and (3) it is, in fact, engaged in instruction in these courses. Form I-17 and Supplements A and/or B may also be used to respond to INS requests for information during periodic reviews of such approval to: (1) notify the INS of any changes to certain school information, and (2) request a change in school classification code. II. Types of Institutions That May Be Considered for Approval. (1) Public school: a school or school system owned and operated as a public educational institution by the United States or a state or political subdivision thereof. (2) Private or parochial school: an elementary or secondary school or school system certified as meeting the requirements of the state or local educational system in which it is located. (3) Other school or school system: a school or school system, not avocational or recreational in character, that is established and has been certified as appropriately licensed, approved or accredited. III. General Filing Instructions. Submit Form I-17 and Supplements A and B to the INS district office having administrative jurisdiction over the area where the school or school system is located. One Form I-17 may be filed for an entire school system if all schools in the system are located in the same INS district. If not, a separate Form I-17 is required for those schools, school-system schools and/or campuses located in different INS districts. Each Form I-17 must be accompanied by Supplement A, Record of Designated School Officials, listing up to five designated school officials for each school or campus within a school system (except an elementary or secondary school system as noted in these instructions on Page 2 under 1. Categories of F-1 Schools). If there is a change in designated school officials, a new Supplement A must be completed and submitted within 30 days to the INS office having jurisdiction over the school. A previously approved school system should submit a new Form I-17, without fee, accompanied by Supplement B and, if applicable, Supplement A, if the school system seeks: (1) approval for schools or campuses not listed on its original Form I-17, or (2) to delete schools or campuses listed on its original Form I-17, or (3) to correct or update information related to approvals or deletions of schools or campuses listed on its original Form I-17. However, Supplements A and B must list only those schools and designated school officials located within the local INS district. If a previously approved school, that was not a school system, becomes a school system and seeks approval for additional schools or campuses, it must submit a new Form I-17, without fee, accompanied by Supplement B, and if applicable, Supplement A. IV. Payment of Fee. No fee is required for public schools or if the petition is for continuation of approval previously granted by INS. Otherwise, for initial approval a fee of $ is required and will not be refunded, regardless of the action taken on the petition. Do not mail cash. All fees must be submitted by check or money order drawn on a bank or other institution located in the United States and be payable in United States currency in the exact amount. If the petitioner resides in Guam and is filing the petition there, the check or money order must be payable to the "Treasurer, Guam." If the petitioner resides in the Virgin Islands and is filing the petition there, the check or money order must be payable to the "Commissioner of Finance of the Virgin Islands." Form I-17 Instructions (Rev. 04/05/02)Y Page 1

2 For all other petitioners, the check or money order must be payable to the "Immigration and Naturalization Service." When a check is drawn on the account of a person other than the petitioner, the name of the petitioner must be entered on the face of the check. Personal checks are accepted subject to collection. An uncollectible check will render the petition and any document issued pursuant to it as invalid, and a charge of $30.00 will be imposed. V. Execution of Petition. A petition filed on behalf of a public school must be made by the school board and signed by its president or chairman. In the case of a petition on behalf of a public school, complete only questions 1 through 7, and 9, 11, 12 and 14. In all other cases, each question on the form must be fully completed. Only those categories of institutions listed at 8 CFR 214.3(a) may be considered for approval. The INS will return a petition that does not clearly identify the category under which the school seeks approval, or indicates eligibility to enroll a classification of students for which it is not eligible (e.g., a vocational school seeking to enroll F-1s). A post-secondary institution that operates a high school and seeks aproval for both post-secondary and high school students must submit two separate petitions with fees. 1. Categories of F-1 Schools: F-1 institutions are: (a) a college or university or community college, junior or two-year college as discussed below: (1) a college or university is an institution of higher learning that awards recognized bachelor's, master's, doctors or professional degrees; (2) a community college, junior or two-year college is an institution that provides instruction in the liberal arts or in the professions and awards recognized associate's degrees. Both categories are distinguished by the award of a recognized degree. NOTE: To qualify as "recognized," a degree must be issued by an institution accredited by a nationally recognized accrediting agency or association to confer a degree of the type and level in question. A nationally recognized accrediting agency is one that has been determined by the Secretary of Education to be a reliable authority as to the quality of the type of instruction in question. (b) a seminary that trains priests, ministers or rabbis and awards a degree or certificate; (c) a conservatory that teaches music or dramatic arts and awards a degree or certificate; (d) a public or private academic high school (grades 9-12) that provides college preparatory instruction. (e) a private elementary school (grades K-8) that includes lower, middle and junior high schools. An institution that provides language training, instruction in the liberal arts or fine arts, or instruction in the professions, or instruction or training in more than one of these disciplines encompasses many types of training programs in which academic requirements (e.g., math, humanities and science) supplement career education. Included are training programs offered at Montessori academies, culinary arts and/or food service management institutes, certain business schools and computer programming schools. NOTE: If such programs described in the paragraph immeditely above award a recognized degree, the school should seek approval as a college or university or a community, junior or two-year college as described above in this section under (a). 2. Categories of M-1 Schools: M-1 schools are community colleges, or junior or two-year colleges that provide vocational or technical training, usually leading to a job rather than a bachelor's degree, and that award recognized associate degrees These schools are discussed below: (a) a vocational high school (grades 9-12) that provides instruction in the trades or technical occupations; (b) a community college or junior college that provides vocational or technical training and awards recognized associate degrees; (c) a school that provides vocational or nonacademic training, other than language training, usually a for-profit (or proprietary) concern that may award a certificate or unrecognized degree, including religious schools, other than seminaries; acting or drama schools, other than conservatories; flight schools, hair styling academies, secretarial schools, acupuncture schools and computer technology institutes. Form I-17 Instructions (Rev. 04/05/02)Y Page 2

3 VI. Supporting Documents. A petition must be submitted with all supporting documentation required by 8 CFR 214.3(b). Please note that a charter is not a license, approval or accreditation. 1. Certifications. (a) A school or school system owned and operated as a public educational institution or system by the United States, or a State or a political subdivision thereof, must submit a certification to that effect, signed by the appropriate public official who must also certify that he or she is authorized to provide such certification. This certification may take the form of a state license or approval. Accreditation may not be substituted for the required certification. (b) A private or parochial elementary or secondary school or school system must meet the requirements of the State or local public educational system, and must submit a certification to that effect, signed by the appropriate public official who must also certify that he or she is authorized to provide such certification. This certification may take the form of a State license or approval. Accreditation may not be substituted for the required certification. (c) All other schools, except as noted in (1) and (2) directly below, must be licensed, approved or accredited and must submit a certification to that effect, signed by the appropriate official who must also certify that he or she is authorized to provide such certification. (1) In lieu of such certification, a school (other than a flight school) that offers courses recognized by a state educational authority as appropriate for study by veterans, under the provisions of 38 USC 3675 and 3676, may submit a statement of recognition for specific programs signed by the appropriate public official, who must also certify that he or she is authorized to do so. The statement of recognition must be for the same program(s) listed on Form I-17. (2) Flight schools must be licensed or approved by the State and approved by the Federal Aviation Administration (FAA) in the form of an "air agency certificate." Flight schools must include a list of authorized courses, instruction ratings and flight hours, and an attachment certifying approval pursuant to FAA regulations, Part 141. Flight schools may also be accredited. However, accreditation may not be substituted for State licensure/approval and FAA approval. 2. Catalogue and/or Written Statement. All petitioning schools, except those listed below under NOTE, must submit a catalogue and/or written statement with the following information: (a) size of physical plant (e.g., description of school buildings and grounds); (b) nature of facilities for study and training (e.g., number and size of classrooms, size of library and number of volumes it contains, specialized facilities, such as laboratories and practice rooms); (c) educational, vocational or professional qualifications of the teaching staff (e.g., resumes or curriculum vitae); (d) salaries of the teachers (i.e., specific salaries or hourly rates of pay); (e) attendance and scholastic grading policy (e.g., when a student's enrollment is terminated for failure to attend classes, when a student is placed on academic probation); (f) amount and character of supervisory and consultative services available to students and trainees (e.g., faculty-to-student ratio, office hours, counseling services, tutoring and mentor programs); (g) current finances, including a copy of accountant's last statement of school's net worth, as well as total income and expenses certified to be true and correct, either by the accountant or by the owner of the petitioning institution. NOTE: Petitioning schools exempted from submitting a catalogue or written statement are: a public school or school system, a school accredited by a nationally recognized accrediting body, or a secondary school operated by or as part of a school so accredited. 3. Other Evidence. The INS, in consultation with the Department of Education, has determined that certain categories of institutions must submit the following evidence in addition to that described above. (a) A vocational, business or language school, or American institution of research recognized as such pursuant to 8 CFR , must submit evidence that its courses of study fulfill the appropriate educational, professional or vocational objective and are not avocational or recreational in character. Evidence of accreditation is sufficient to meet this requirement. Otherwise, these documents must be submitted: Form I-17 Instructions (Rev. 04/05/02)Y Page 3

4 (1) For institutions seeking F-1 approval and vocational schools that award recognized associate degrees: letters from at least three accredited institutions attesting that graduates from the petitioning institution have been and are accepted unconditionally. Such letters must be written on institutional letterhead and state the name of the petitioning school, name(s) of the graduate(s), date(s) of enrollment and the new program(s) of the graduate(s). OR (2) For all OTHER institutions seeking M-1 approval that do not award recognized associate degrees: letters from at least three employers attesting that recent graduates of the school (within the last two years) are fully qualified in the field of training. Such letters must be written on company letterhead and state the name and title or position of the graduate, the school from which he or she was graduated and dates of employment with the firm. Letters from self-employed graduates are not acceptable. (b) A post-secondary institution that is not publicly owned and operated or accredited by a nationally recognized accrediting body must submit evidence that its credits have been and are accepted unconditionally by at least three accredited institutions of higher education. Submit evidence described in (1) or (2) immediately below to meet this evidentiary requirement. (1) For institutions seeking F-1 and/or M-1 approval, letters on institutional letterhead from at least three accredited institutions attesting that the accredited institution unconditionally accepts and has accepted credits from the petitioning institution. Such letters must state the name of the petitioning school, name(s) of its graduate(s), date(s) of enrollment at the accredited institution, and the program(s) in which the petitioner's graduate(s) enrolled at the institution. OR (2) Evidence that the institution or program has established satisfactory assurance of accreditation from the appropriate accrediting body. (Often referred to as "pre-accreditation" or "candidate for accreditation" status, such assurance is only available from a very limited number of nationally recognized agencies.) (c) An elementary or secondary school that is neither publicly owned and operated, nor owned and operated by an accredited post-secondary institution, must submit evidence that attendance satisfies the compulsory attendance requirements of the State in which it is located. Such evidence must state also that graduation from the petitioning school qualifies students for acceptance by schools of higher educational level that are either publicly owned and operated or accredited, or owned and operated by an accredited institution. The following documents meet this evidentiary requirement: (1) a certificate of accreditation or approval from the appropriate local educational agency, if such an agency is required by the State to approve private schools through an on-site team visit using local or State approved standards; or (2) a certificate of accreditation or successful evaluation by an organization holding membership in the Council for American Private Education (1726 M St., NW, Washington, DC 20036, tel ), or the American Association of Christian Schools (PO Box 2189, Independence, MO 64055; tel , fax ); and (3) letters from at least three institutions of higher educational level that are either publicly owned and operated or accredited, or owned and operated by an accredited institution attesting that graduates from the petitioning institution have been and are accepted unconditionally. Such letters must be written on institutional letterhead and state the name(s) of the petitioning school, the name(s) of the graduate(s), date(s) of enrollment and the new program(s) of the graduate(s). VII. Eligibility for Approval. A school petitioning for approval must demonstrate that: (1) it is actually engaged in instruction of the courses listed on this form; and (2) it provides sufficient class hours to enable students to pursue a full course of study, according to the regulations at 8 CFR 214.2(f) and 214.2(m). Form 1-17 Instructions (Rev. 04/05/02)Y Page 4

5 VIII. Review of School Approval. The INS district director may periodically review the approval of a school in his or her jurisdiction for compliance with the reporting requirements of 8 CFR 214.3(g)(2) and for continued eligibility for approval pursuant to 8 CFR 214.3(e). The district director shall also, upon receipt of notification, evaluate any changes made to the name, address or curriculum of an approved school to determine if the changes have affected the school's eligibiliy for approval. The district director may require a currently executed Form I-17, without fee, and supporting documentation, if there is a question whether the school still meets the eligibility requirements. If the district director finds that the approval should not be continued, he or she shall institute withdrawal proceedings in accordance with 8 CFR 214.4(b). IX. Interview of Petitioner/Site Visit. An authorized representative of the petitioner shall appear in person before an INS officer prior to the adjudication of the petition to be interviewed under oath concerning the eligibility of the school for approval. An interview may be waived and/or an INS officer may visit the petitioning school at the discretion of the district director. The findings of any interview/site visit will be documented for the petition record. XII. Information and Forms. For information on immigration laws, regulations and procedures and to order INS forms, call our National Customer Service Center toll-free at or visit the INS internet web site at XIII. Reporting Burden. A person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Public reporting burden for this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: Immigration and Naturalization Service, HQPDI, 425 I Street, N.W., Room 4307r, Washington, DC 20536; OMB No DO NOT MAIL YOUR COMPLETED APPLICATION TO THIS ADDRESS. X. Notification of Action on Petition. Upon final action on the petition, the petitioner will be notified of the decision. If the petition is approved, the petitioner will be provided with copies of the pertinent regulations, a limited number of the required forms and other basic information. If the petition is denied, the petitioner may file a motion to reopen or reconsider the decision, stating either the new facts to be proved at the reopened proceedings or the reasons for reconsideration. A denial may also be appealed in accordance with provisions at 8 CFR 103. XI. Authority. The information on this form is requested to carry out the immigration laws contained in Title 8, United States Code. The information provided may be disclosed to other federal, state, local and foreign law enforcement and regulatory agencies during the course of an investigation required by INS. The petitioner does not have to give this information. However, if the petitioner refuses to give some or all of it, the petition may be denied. Form 1-17 Instructions (Rev. 04/05/02)Y Page 5

6 U.S. Department of Justice Immigration and Naturalization Service OMB # Petition for Approval of School for Attendance by Nonimmigrant Student START HERE- Please read instructions before beginning. Type or print in black or dark blue ink. THIS SECTION IS TO BE COMPLETED BY THE SCHOOL. If more space is needed to fully answer any items on this form, use a separate sheet(s). Identify each answer with the letter and number of the corresponding item and sign and date each sheet. Indicate that an item is not applicable with "N/A." If the answer is "none," please write "none." This application must be filed with the required evidence as noted below, be properly signed and submitted with the correct fee. To the Immigration and Naturalization Service: 1. Petition is made for approval, or continuation of approval, of this institution as a school for attendance by nonimmigrant alien students under (complete as appropriate): a. Section 10l(a)(15)(F) of the Act (academic and language students), b. Section l0l(a)(15)(m) of the Act (vocational students), c. Both of the above sections of the Act, 2. Name of school: FOR INS USE ONLY School Code 214F Approval for attendance of students under: 1. Section 101(a)(15)(F) of the Act. 2. Section 101(a)(15)(M) of the Act. 3. Both of the above sections of the Act. This request is to: 1. Create a file. 2. Update a file. Fee Stamp: 3. Mailing address of school: Action Stamp 4. This school is a: a. Publicly owned institution (Leave No.10 blank). b. Private Institution (Complete No.10). 5. This school is engaged in: (Check appropriate blocks and explain further if necessary). a. Elementary education including lower, middle and junior high schools. b. High school education (academic or vocational). c. Vocational or technical education (other than high school). Remarks d. Language training. e. Higher education (issuing one or more of the following recognized degrees: Bachelor's, Associate's, Master's, Ph.D.). f. Other (explain) 6. This school's sessions are based on: a. Semesters c. Quarters b. Trimesters d. Other (explain) 7. Provide the date and month registration begins for EACH session during a calendar year, including the summer session, if your school has one. a. d. g. j. b. e. h. k. c. f. i. l. If there is no beginning registration date, please explain: 8. Date school was established: (i.e., 9. enrolled first class of students) Location of school: (if different from mailing address) 10. Name, address and telephone number of owner: 11. Petition is for: a. Initial approval. b. Continuation of approval. Please complete the following: (i) Date of original approval 12. The school operates under the following state, local or other license or approval (if none, write "none"): (ii) INS school code 13. The school has been approved by the following nationally recognized accrediting association or agency (if none, write "none"): Received Ret'd-Trans. Out Trans. In Completed Continued on next page Form I-17 (Rev. 04/05/02)Y Page 1

7 14. Nature of subject matter taught (check as many as are appropriate): a. b. c. d. e. f. g. Liberal Arts (i.e., those fields of study of general cultural concern such, as philosophy or history and, in some cases, theology). Fine Arts (i.e., those that exist chiefly for beauty, such as sculpture and painting, as opposed to utility). Professional Studies (e.g., architecture, engineering, law, medicine and education). Religious Language Vocational or Technical Training (i.e., training relating to a trade, technique or mechanical or industrial skill). Other (Explain): 15. List the degrees available from the school: 16. Check as appropriate and explain further if necessary: If the school is engaged in elementary or secondary education, it: does does not qualify its graduates for acceptance by accredited schools of higher educational level. If the school is engaged in higher education, it: does does not confer recognized bachelor's, master's, doctor's, professional or divinity degrees. Its degrees are are not transferable to institutions of study that confer such degrees. If the school is engaged in vocational or technical education, it does does not qualify its graduates for employment. 17. Sessions are held as follows: a. 18. Requirements for admission: Day only b. Night only c. Day and night 19. Courses of study and time necessary to complete each course: 20. Requirements for graduation: 21. Causes for expulsion: 22. Average annual number of: a. Classes: b. Students: c. Teachers or instructors: d. Non-teaching employees: 23. Approximate annual total cost of room, board, tuition, etc., per student. $ Continued on next page Form 1-17 (Rev. 04/05/02)Y Page 2

8 U.S. Department of Justice Immigration and Naturalization Service OMB No Record of Designated School Officials Instructions (1) Form I-17, Supplement A, listing up to five designated school officials for each school or campus within a school system (except an elementary or secondary school system as noted below), must be attached to each Form I-17, Petition for Approval of School for Admittance by Nonimmigrant Students. If there is a change in designated school officials, a new Supplement A must be completed and submitted within 30 days to the Immigration and Naturalization Service (INS) office having jurisdiction over the school. (2) "Designated School Official" (DSO), as defined in 8 CFR 214.3, means a regularly employed member of the school administration whose office is located at the school and whose compensation does not come from commissions for recruitment of foreign students. A DSO may not delegate this designation to any other person. An individual whose principal obligation to the school is to recruit foreign students for compensation may not be a DSO. The DSO is required to have a thorough knowledge of the regulations, policies and procedures governing nonimmigrant students. Each school or institution may have up to five DSOs at any one time. In an elementary or secondary school system, however, the entire school system is limited to a total of five designated officials at any one time. DSO Intention to Comply With Pertinent INS Student/School Regulations I, THE UNDERSIGNED, have read the Immigration and Naturalization Service's regulations relating to nonimmigrant students, namely 8 CFR 214.1, 8 CFR 214.2(f) and/or 8 CFR 214.2(m); the INS regulations relating to change of nonimmigrant classification for students, namely 8 CFR 248; the INS regulations relating to school approval and withdrawal of school approval, namely 8 CFR and 214.4, and intend to comply with these regulations at all times. Designated Official: Last and First Name: (Print or Type) Title Signature Telephone number Initial designation Replacement for prior designated official Correction to previous designation Designated Official: Last and First Name (Print or Type) Title Signature Telephone number Initial designation Replacement for prior designated official Correction to previous designation Designated Official: (Print or Type) Title Signature Telephone number Last and First Name Initial designation Replacement for prior designated official Correction to previous designation Designated Official: Last and First Name (Print or Type) Title Signature Telephone number Initial designation Replacement for prior designated official Correction to previous designation Designated Official: Last and First Name (Print or Type) Title Signature Telephone number Initial designation Replacement for prior designated official Correction to previous designation Continued on next page Form I-17 (Rev. 04/05/02) Supplement A Page 1

9 Certification By President, Owner or Head of School or School System I, the undersigned president, owner or head of the school or school system named below certify that the above individuals are designated school officials of the school or school system. Further, I certify that I will be responsible for providing the resources and training necessary for these officials to properly implement the above referenced regulations. Name (Print or Type) Title (Print or Type) Signature Name of school system, school or campus (list all schools or campuses and their three-digit suffixes for which the above officials are designated, if for more than one school or campus, but not for the entire school system). INS FILE No., if known: 214F Date: (If this is a multi-campus institution or school system, use the 3-digit suffix for the main or initial campus.) Address of school system, school or campus: Form I-17 (Rev. 04/05/02)Y Supplement A Page 2

10 U.S. Department of Justice Immigration and Naturalization Service OMB No Record of School(s)/Campus(es) Instructions Form I-17 Supplement B must be completed and submitted with Form I-17 if a school system or multi-campus institution is seeking approval for a number of schools for admittance by nonimmigrant students. Furnish all known information for each school or campus within the system. If more space is needed to list all schools, attach additional forms as necessary, and number each at the bottom. If an approved school system seeks to update or correct the information on its original Supplement B, a new Form I-17 must be submitted, without fee, accompanied by Supplement B, and if applicable, Supplement A. Please PRINT or TYPE all information on this form. Requested a. b. c. d. Initial approval for the following school(s) or Addition of the following school(s) or campus(es) to the list of approved institutions within the above school system. Removal of the following school(s) or campus(es) from the list of approved institutions within the above school system. Change or correction in the following information relating to school (s) or campus(es) that have been approved. Fill in only the information that is to be added to or adjusted in the INS records and the school's three-digit suffix. 1. School or Campus Name 2. School or Campus three-digit suffix 3. Mailing Address (include Zip Code) 4. Location (if different from mailing address) 1. School or Campus Name 2. School or Campus three-digit suffix 3. Mailing Address (include Zip Code) 4. Location (if different from mailing address) 1. School or Campus Name 2. School or Campus three-digit suffix 3. Mailing Address (include Zip Code) 4. Location (if different from mailing address) 1. School or Campus Name 2. School or Campus three-digit suffix 3. Mailing Address (include Zip Code) 4. Location (if different from mailing address) Form I-17 (Rev. 04/05/02) Supplement B

11 Execution of Petition If the school is approved, The Petitioner Agrees: Upon acceptance of any nonimmigrant alien student, to furnish that student a Certificate of Eligibility, Form I-20A/B for an F-1 student, or Form I-20M/N for an M-1 student. To keep records containing the following specific information and documents relating to each nonimmigrant F-1 or M-1 student to whom the school issues a Form I-20A/B or I-20M/N, while the student is attending the school and until the school notifies the INS in accordance with regulations at 8 CFR 214.3, that the student is no longer pursuing a full course of study. The school must keep a record of having complied with the reporting requirements for at least one year. If a student out of status is restored to status, the school that enrolled the student must maintain these records following receipt of notification from the INS that the student's status has been restored. The school must keep and, upon request, make available to the INS the following information and documents for each nonimmigrant F-1 and/or M-1 student: a. b. c. d. e. f. g. h. i. j. k. l. Name. Date and place of birth. Country of citizenship. Address Status, i.e., full-time or part-time. Date of commencement of studies. Degree program and field of study. Whether the student has been certified for practical training and the beginning and ending dates of certification. Termination date and reason, if known. Documents referred to in paragraph 212.3(k) regarding the Certificate of Eligibility. Number of credits completed each semester. Photocopy of the student's I-20 ID Copy. 3. That in any advertisement, catalogue, brochure, literature or other material produced by or for this school, any statement that may appear concerning approval for admittance by nonimmigrant students must be limited to the following: "This school is authorized under Federal law to enroll nonimmigrant students." I certify that I am authorized to execute this petition. I understand that unless this institution fully complies with all terms as described on this form, approval may be withdrawn pursuant to 8 CFR Dated at:, this day of, Signature: Name and Title: (CORPORATE SEAL OF INSTITUTION) Form I-17 ( Rev. 04/05/02)Y Page 3